NPI | 1033519780 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9111243) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 2393) |
363AS0400X Physician Assistant, Surgical (Licence: SC 2279PA) | |
Enumeration Date | 2014-08-31 |
Last Update Date | 2023-12-26 |