NPI | 1932116001 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA050827) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0011979) |
Enumeration Date | 2006-08-02 |
Last Update Date | 2023-11-20 |