NPI | 1821538653 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA110201) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9110201) |
Enumeration Date | 2017-02-27 |
Last Update Date | 2021-09-16 |