NPI | 1003893504 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9103321) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9103321) |
Enumeration Date | 2005-12-27 |
Last Update Date | 2020-10-07 |