NPI | 1902427776 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA207556) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA70030324) |
Enumeration Date | 2020-05-02 |
Last Update Date | 2025-09-29 |