NPI | 1174992465 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9108938) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PAT 9108938) |
363AS0400X Physician Assistant, Surgical (Licence: FL PA 9108938) | |
Enumeration Date | 2015-09-17 |
Last Update Date | 2022-12-23 |