NPI | 1255589107 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9112104) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 23012692) |
Enumeration Date | 2008-09-04 |
Last Update Date | 2023-01-24 |