NPI | 1366459224 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-00321) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AR PA-1270) |
Enumeration Date | 2006-08-02 |
Last Update Date | 2024-06-05 |