NPI | 1396141974 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 7425) |
Additional Taxonomies | 363A00000X Physician Assistant |
363A00000X Physician Assistant (Licence: NC 0010-13479) | |
363AS0400X Physician Assistant, Surgical (Licence: GA 007425) | |
Enumeration Date | 2014-11-10 |
Last Update Date | 2024-06-05 |