NPI | 1982930301 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: TN 1771) |
Enumeration Date | 2009-10-20 |
Last Update Date | 2023-12-07 |