NPI | 1609839976 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA2325) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA2325) |
Enumeration Date | 2006-04-08 |
Last Update Date | 2023-10-06 |