NPI | 1821325846 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5422) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 5422) |
363AS0400X Physician Assistant, Surgical (Licence: RI PA 00533) | |
363AS0400X Physician Assistant, Surgical (Licence: AZ 5422) | |
Enumeration Date | 2009-11-12 |
Last Update Date | 2025-04-25 |