NPI | 1659259679 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9120662) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9120662) |
Enumeration Date | 2025-08-26 |
Last Update Date | 2025-09-24 |