NPI | 1669130373 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA063264) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA063264) |
Enumeration Date | 2021-11-30 |
Last Update Date | 2022-01-05 |