NPI | 1518310333 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 55591) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 3746) |
363AS0400X Physician Assistant, Surgical (Licence: CT 3746) | |
Enumeration Date | 2016-07-16 |
Last Update Date | 2024-06-21 |