NPI | 1427593136 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9119152) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1804) |
Enumeration Date | 2017-01-04 |
Last Update Date | 2024-12-20 |