NPI | 1699224014 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA058762) |
Enumeration Date | 2016-09-27 |
Last Update Date | 2024-09-30 |