NPI | 1699833145 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9112176) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0000477) |
363A00000X Physician Assistant (Licence: VA 0110006202) | |
363A00000X Physician Assistant (Licence: MT 143035) | |
363AS0400X Physician Assistant, Surgical (Licence: PA MA002332L) | |
363AS0400X Physician Assistant, Surgical (Licence: DE C5-0000477) | |
Enumeration Date | 2006-12-05 |
Last Update Date | 2024-07-17 |