NPI | 1265997225 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 7456) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2019-02-04 |
Last Update Date | 2023-04-04 |