NPI | 1386011757 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9109020) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10003897A) |
Enumeration Date | 2015-09-01 |
Last Update Date | 2024-10-25 |