NPI | 1154954287 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9112785) |
Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL 9112785) |
Enumeration Date | 2020-02-17 |
Last Update Date | 2024-02-28 |