NPI | 1649206517 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9101653) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9101653) |
Enumeration Date | 2006-06-23 |
Last Update Date | 2021-03-18 |