NPI | 1396214748 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IN 10003985A) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-08368) |
363A00000X Physician Assistant (Licence: AL PA.1514) | |
Enumeration Date | 2018-11-15 |
Last Update Date | 2023-04-21 |