NPI | 1538819818 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9696) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 1237) |
363A00000X Physician Assistant (Licence: FL TPPA338) | |
Enumeration Date | 2022-03-28 |
Last Update Date | 2024-04-11 |