NPI | 1770974727 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
Enumeration Date | 2015-02-12 |
Last Update Date | 2018-11-14 |