NPI | 1538537782 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: AZ 6651) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical |
Enumeration Date | 2015-09-04 |
Last Update Date | 2022-07-21 |