NPI | 1568616027 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 21491) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 4287) |
Enumeration Date | 2008-11-11 |
Last Update Date | 2022-04-25 |