NPI | 1851926158 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA113159) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2020-03-06 |
Last Update Date | 2024-07-12 |