NPI | 1285147447 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9110760) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: FL 9110760) |
Enumeration Date | 2017-11-09 |
Last Update Date | 2023-11-07 |