NPI | 1700167616 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C06717) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 015066) |
Enumeration Date | 2011-09-06 |
Last Update Date | 2024-08-08 |