NPI | 1457379117 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MO 2022016230) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA13981) |
Enumeration Date | 2006-07-18 |
Last Update Date | 2022-06-06 |