NPI | 1558540500 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA1917) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA1917) |
Enumeration Date | 2007-10-26 |
Last Update Date | 2024-02-27 |