NPI | 1043683311 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9109111) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: GA 10558) |
Enumeration Date | 2015-11-09 |
Last Update Date | 2023-11-27 |