NPI | 1992112163 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9114697) |
Enumeration Date | 2014-07-18 |
Last Update Date | 2021-10-14 |