NPI | 1275224388 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA221482) |
Additional Taxonomies | 363A00000X Physician Assistant |
363AS0400X Physician Assistant, Surgical (Licence: TX PA16887) | |
Enumeration Date | 2023-05-18 |
Last Update Date | 2024-09-23 |