NPI | 1801198635 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9104883) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9104883) |
Enumeration Date | 2010-11-30 |
Last Update Date | 2023-09-21 |