NPI | 1437774858 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA7584) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2020-06-11 |
Last Update Date | 2021-02-08 |