NPI | 1093728602 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9101047) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9101047) |
Enumeration Date | 2006-08-14 |
Last Update Date | 2013-06-21 |