NPI | 1396497442 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4957) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: TN 4957) |
Enumeration Date | 2022-01-20 |
Last Update Date | 2022-06-29 |