NPI | 1689962581 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MD C004461) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 6134) |
363AM0700X Physician Assistant, Medical (Licence: VA 0110003650) | |
363AM0700X Physician Assistant, Medical (Licence: FL PA9117365) | |
Enumeration Date | 2011-07-13 |
Last Update Date | 2024-10-17 |