NPI | 1619504529 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: GA 9700) |
Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: GA 9700) |
363AM0700X Physician Assistant, Medical (Licence: GA 9700) | |
363AM0700X Physician Assistant, Medical (Licence: TN 4504) | |
Enumeration Date | 2020-03-23 |
Last Update Date | 2025-08-06 |