NPI | 1326195173 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AL PA.763) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MO 2023025752) |
Enumeration Date | 2007-01-04 |
Last Update Date | 2024-04-30 |