NPI | 1821982075 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 7164) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 1211327) |
Enumeration Date | 2025-06-04 |
Last Update Date | 2025-08-15 |