NPI | 1922446020 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WI 313223) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 313223) |
Enumeration Date | 2013-06-11 |
Last Update Date | 2021-12-20 |