NPI | 1962019182 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AR PA-931) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AR PA-931) |
Enumeration Date | 2020-09-30 |
Last Update Date | 2020-10-25 |