NPI | 1235652827 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9110495) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0001274) |
363A00000X Physician Assistant (Licence: FL PA9110495) | |
Enumeration Date | 2017-07-25 |
Last Update Date | 2025-06-03 |