NPI | 1891777645 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1703) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SD 0650) |
363AS0400X Physician Assistant, Surgical (Licence: IA 01626) | |
Enumeration Date | 2005-11-17 |
Last Update Date | 2023-12-13 |