NPI | 1497843643 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9117438) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9117438) |
363AM0700X Physician Assistant, Medical (Licence: MI 5601003596) | |
Enumeration Date | 2006-10-11 |
Last Update Date | 2023-10-30 |