NPI | 1578975082 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 7179) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO PA0004275) |
Enumeration Date | 2014-06-02 |
Last Update Date | 2024-04-26 |