NPI | 1477071108 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9112207) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-07532) |
Enumeration Date | 2017-09-01 |
Last Update Date | 2024-12-31 |