NPI | 1174021869 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9110951) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2018-01-27 |
Last Update Date | 2018-04-23 |