NPI | 1619993854 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IN 10000705A) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IN 10000705A) |
Enumeration Date | 2006-07-14 |
Last Update Date | 2022-06-20 |