NPI | 1598956633 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.002628) |
Enumeration Date | 2007-08-05 |
Last Update Date | 2021-01-13 |