NPI | 1376637660 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601004872) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MI 5601004872) |
Enumeration Date | 2006-10-03 |
Last Update Date | 2023-11-27 |