NPI | 1285328161 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 10777) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2023-06-05 |
Last Update Date | 2024-10-23 |