NPI | 1841668910 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA8312) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: RI PA00836) |
Enumeration Date | 2015-09-08 |
Last Update Date | 2024-06-06 |