| NPI | 1083243604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 10183) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 000372-P.A.) |
| 363A00000X Physician Assistant (Licence: FL TPPA633) | |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2024-04-18 |