NPI | 1831151125 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9105464) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C00332) |
363A00000X Physician Assistant (Licence: FL PA9109616) | |
Enumeration Date | 2006-04-04 |
Last Update Date | 2020-08-28 |