NPI | 1740900927 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9116438) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2022-08-30 |
Last Update Date | 2025-04-22 |