NPI | 1588844351 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9107328) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: HI AMD-309) |
Enumeration Date | 2007-11-09 |
Last Update Date | 2019-11-19 |