NPI | 1164804779 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9113946) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: LA 200831) |
Enumeration Date | 2015-06-19 |
Last Update Date | 2023-09-13 |