NPI | 1902219447 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05133) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2014-06-03 |
Last Update Date | 2023-08-02 |