NPI | 1780883785 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C03063) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 008146) |
Enumeration Date | 2007-07-11 |
Last Update Date | 2024-09-30 |