NPI | 1013308741 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9109741) |
Additional Taxonomies | 363A00000X Physician Assistant |
363AS0400X Physician Assistant, Surgical (Licence: MD C05700) | |
Enumeration Date | 2015-02-17 |
Last Update Date | 2021-03-16 |