NPI | 1902294226 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-05442) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05442) |
Enumeration Date | 2015-01-08 |
Last Update Date | 2024-09-12 |