| NPI | 1033519780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9111243) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SC 2279PA) |
| 363A00000X Physician Assistant (Licence: SC 2393) | |
| Enumeration Date | 2014-08-31 |
| Last Update Date | 2024-11-14 |