NPI | 1073936738 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN PA3383) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9109353) |
363A00000X Physician Assistant (Licence: NY 017342) | |
Enumeration Date | 2014-01-30 |
Last Update Date | 2022-03-23 |