NPI | 1295724920 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA3597) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-03520) |
Enumeration Date | 2005-10-15 |
Last Update Date | 2013-01-03 |