NPI | 1699876862 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 2632) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 8526-23) |
Enumeration Date | 2006-09-26 |
Last Update Date | 2025-09-17 |