NPI | 1548815848 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9112455) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2019-08-05 |
Last Update Date | 2022-02-08 |