NPI | 1467404905 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA3058) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA3058) |
Enumeration Date | 2006-05-16 |
Last Update Date | 2023-01-20 |