NPI | 1477945798 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9115383) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2015-02-24 |
Last Update Date | 2024-10-01 |