NPI | 1821481615 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9108615) |
Additional Taxonomies | 208M00000X Hospitalist (Licence: FL PA9108615) |
363AS0400X Physician Assistant, Surgical (Licence: FL PA9108615) | |
Enumeration Date | 2015-03-18 |
Last Update Date | 2025-06-30 |