NPI | 1972672160 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9103934) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9103934) |
Enumeration Date | 2006-11-06 |
Last Update Date | 2022-07-21 |