NPI | 1417547555 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA213402) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 1180085) |
Enumeration Date | 2021-01-22 |
Last Update Date | 2025-07-15 |