NPI | 1952381162 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA002741L) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA002741L) |
Enumeration Date | 2006-01-23 |
Last Update Date | 2023-11-17 |