NPI | 1871791087 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C03547) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C03547) |
363AM0700X Physician Assistant, Medical (Licence: MD C03547) | |
Enumeration Date | 2007-07-10 |
Last Update Date | 2021-03-04 |