NPI | 1710291612 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 1720) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: HI AMD-1089) |
363AS0400X Physician Assistant, Surgical (Licence: SC 1720) | |
Enumeration Date | 2010-08-03 |
Last Update Date | 2025-04-24 |