NPI | 1326345422 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9105927) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9105927) |
Enumeration Date | 2011-02-25 |
Last Update Date | 2015-01-23 |