NPI | 1508622309 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA065393) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA065393) |
Enumeration Date | 2024-02-28 |
Last Update Date | 2024-02-28 |