NPI | 1356685499 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110004077) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110004077) |
Enumeration Date | 2012-11-15 |
Last Update Date | 2021-07-08 |