NPI | 1821516527 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: LA 306986) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: LA 306986) |
Enumeration Date | 2017-09-01 |
Last Update Date | 2020-03-03 |