NPI | 1659890754 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 6888) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 6888) |
Enumeration Date | 2017-09-11 |
Last Update Date | 2022-10-12 |