| NPI | 1093731283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9103141) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA91031) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2023-02-23 |