| NPI | 1063432078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9102774) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL pa9102774) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2023-12-21 |