NPI | 1144692898 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-06880) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 4816) |
363A00000X Physician Assistant (Licence: FL TPPA946) | |
Enumeration Date | 2015-10-21 |
Last Update Date | 2025-07-30 |