NPI | 1619918919 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9110525) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: ME PA-654) |
Enumeration Date | 2006-06-09 |
Last Update Date | 2018-07-05 |