NPI | 1083688626 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA96107275) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9107275) |
Enumeration Date | 2006-02-13 |
Last Update Date | 2023-11-06 |