NPI | 1851623136 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9115279) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 11595) |
Enumeration Date | 2010-02-11 |
Last Update Date | 2022-09-21 |