NPI | 1447074703 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA223066) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA223066) |
Enumeration Date | 2024-11-13 |
Last Update Date | 2025-07-18 |