NPI | 1720066822 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL PA3711) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA3711) |
Enumeration Date | 2006-01-09 |
Last Update Date | 2021-05-14 |