NPI | 1295189066 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ID PA-2226) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60692737) |
Enumeration Date | 2016-04-19 |
Last Update Date | 2023-04-13 |