NPI | 1396284154 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 4028-023) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2017-02-13 |
Last Update Date | 2021-12-14 |