NPI | 1942421110 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9116539) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA003414L) |
Enumeration Date | 2007-05-02 |
Last Update Date | 2023-05-18 |