NPI | 1891400735 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.008035RX) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 56010111628) |
Enumeration Date | 2023-01-16 |
Last Update Date | 2023-03-15 |