NPI | 1023194750 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9103819) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA12718) |
Enumeration Date | 2006-10-27 |
Last Update Date | 2009-03-05 |