NPI | 1851800874 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9110665) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2017-09-21 |
Last Update Date | 2022-05-12 |