NPI | 1518206291 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-04981) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9107064) |
Enumeration Date | 2013-01-31 |
Last Update Date | 2023-12-05 |