NPI | 1366535296 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA 2769) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 53408) |
363A00000X Physician Assistant (Licence: WA 60999946) | |
Enumeration Date | 2006-10-02 |
Last Update Date | 2024-10-29 |