NPI | 1487938833 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9109474) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9109474) |
Enumeration Date | 2011-10-04 |
Last Update Date | 2021-10-22 |