NPI | 1033142591 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9103610) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 009738) |
Enumeration Date | 2006-07-08 |
Last Update Date | 2021-11-11 |