NPI | 1699218024 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9110038) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9110038) |
363AS0400X Physician Assistant, Surgical (Licence: FL PA9110038) | |
Enumeration Date | 2016-12-03 |
Last Update Date | 2022-10-20 |