NPI | 1811337017 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ID PA-2126) |
Additional Taxonomies | 104100000X Social Worker (Licence: ID LMSW # 33052) |
Enumeration Date | 2013-07-02 |
Last Update Date | 2022-01-17 |