NPI | 1629515135 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9084) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: AZ 9084) |
Enumeration Date | 2017-01-22 |
Last Update Date | 2023-09-05 |