NPI | 1902170327 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9106442) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9106442) |
Enumeration Date | 2012-03-02 |
Last Update Date | 2017-07-07 |