NPI | 1952709008 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SC 2227) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC 2227) |
Enumeration Date | 2014-12-05 |
Last Update Date | 2024-10-04 |