| NPI | 1063268209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL TPPA690) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 2146-PA) |
| Enumeration Date | 2024-04-29 |
| Last Update Date | 2024-05-24 |