NPI | 1417574450 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9112833) |
Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: FL PA9112833) |
207KA0200X Allergy & Immunology, Allergy (Licence: FL PA9112833) | |
Enumeration Date | 2020-06-25 |
Last Update Date | 2024-07-02 |