NPI | 1295410876 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 11756) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2023-06-20 |
Last Update Date | 2023-07-10 |