NPI | 1083676779 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9101893) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2006-04-06 |
Last Update Date | 2023-05-01 |