NPI | 1538134721 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 10629) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9110302) |
363A00000X Physician Assistant (Licence: VA 0110-010484) | |
363A00000X Physician Assistant (Licence: IL 085.010957) | |
Enumeration Date | 2006-02-21 |
Last Update Date | 2025-07-31 |