NPI | 1447229760 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9102043) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA G247922842) |
Enumeration Date | 2006-03-17 |
Last Update Date | 2022-09-28 |