NPI | 1801212923 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA056865) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical |
Enumeration Date | 2014-03-13 |
Last Update Date | 2020-08-26 |