NPI | 1013015353 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9102443) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9102443) |
Enumeration Date | 2006-09-20 |
Last Update Date | 2012-06-25 |