NPI | 1316902489 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA3777) |
Additional Taxonomies | 174400000X Specialist (Licence: RI AT00163) |
363A00000X Physician Assistant (Licence: RI PA00486) | |
363AS0400X Physician Assistant, Surgical (Licence: NY 013021) | |
Enumeration Date | 2006-04-20 |
Last Update Date | 2025-04-18 |