NPI | 1144934589 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9117435) |
Additional Taxonomies | 363A00000X Physician Assistant |
363A00000X Physician Assistant (Licence: OK 4971) | |
Enumeration Date | 2023-01-10 |
Last Update Date | 2025-07-09 |