NPI | 1730755323 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC MPA.5748PA) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9114555) |
363AS0400X Physician Assistant, Surgical | |
Enumeration Date | 2021-06-03 |
Last Update Date | 2025-05-15 |