NPI | 1609006527 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006995) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0011868) |
363AS0400X Physician Assistant, Surgical | |
363A00000X Physician Assistant (Licence: CA PA-2063) | |
Enumeration Date | 2009-07-27 |
Last Update Date | 2024-08-29 |