| NPI | 1376172015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1610) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 023661) |
| 363A00000X Physician Assistant (Licence: PR 000229-P.A) | |
| 363A00000X Physician Assistant (Licence: AZ 8363) | |
| 363A00000X Physician Assistant (Licence: FL TPPA363) | |
| Enumeration Date | 2020-04-04 |
| Last Update Date | 2024-03-08 |