| NPI | 1003291428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9109498) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2016-10-16 |