NPI | 1851403281 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA2690) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL PA2690) |
Enumeration Date | 2006-08-31 |
Last Update Date | 2013-08-08 |