NPI | 1306485917 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TN 4070) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TN 4070) |
Enumeration Date | 2019-12-30 |
Last Update Date | 2020-06-02 |