NPI | 1285660886 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9102865) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 146165) |
Enumeration Date | 2006-06-24 |
Last Update Date | 2022-07-21 |