NPI | 1548830854 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C08156) |
Additional Taxonomies | 363A00000X Physician Assistant |
363AS0400X Physician Assistant, Surgical | |
Enumeration Date | 2021-06-29 |
Last Update Date | 2024-01-04 |