NPI | 1295458347 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 7165-23) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2022-09-23 |
Last Update Date | 2023-01-03 |