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Individual
BRUNO GRILLO
Active
Individual
BRUNO GRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004809
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105882400L
—
GA
05
—
105882400N
—
GA
Enumeration date
10/25/2006
Last updated
06/27/2012
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