NPI | 1578804183 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9101013) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9101013) |
Enumeration Date | 2013-03-06 |
Last Update Date | 2025-07-28 |