NPI | 1447361746 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9102205) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-06098) |
363A00000X Physician Assistant (Licence: MI 5601005453) | |
Enumeration Date | 2006-08-31 |
Last Update Date | 2025-10-06 |