NPI | 1609829274 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 3116) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NV PA1847) |
Enumeration Date | 2006-05-17 |
Last Update Date | 2021-08-20 |