NPI | 1982365854 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA066297) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2022-01-04 |
Last Update Date | 2025-08-08 |