NPI | 1285035857 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C05523) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C05523) |
363AS0400X Physician Assistant, Surgical (Licence: MD C05523) | |
Enumeration Date | 2014-09-14 |
Last Update Date | 2023-12-06 |