| NPI | 1114106051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL 9100415) |
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: FL 9100415) |
| Enumeration Date | 2007-10-28 |
| Last Update Date | 2020-01-09 |