NPI | 1689625550 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 103834) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NC 103834) |
Enumeration Date | 2006-05-15 |
Last Update Date | 2023-05-02 |