NPI | 1821492323 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 57632) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA1551) |
363AS0400X Physician Assistant, Surgical (Licence: MD C0005588) | |
Enumeration Date | 2014-10-14 |
Last Update Date | 2023-06-29 |