NPI | 1760540413 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OK 1100) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2006-12-05 |
Last Update Date | 2020-08-27 |