NPI | 1639849987 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OR PA206399) |
Enumeration Date | 2021-09-17 |
Last Update Date | 2025-08-20 |