NPI | 1407859077 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-13142) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 001072) |
363A00000X Physician Assistant (Licence: FL PA2336) | |
Enumeration Date | 2005-05-27 |
Last Update Date | 2023-03-24 |