| NPI | 1083272959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PACN39) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PR 376-P.A.) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2025-05-10 |