| NPI | 1134595879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9114405) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 018936) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2023-05-06 |