| NPI | 1144037953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PR 1569-PA) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 10239) |
| 363A00000X Physician Assistant (Licence: FL TPPA619) | |
| Enumeration Date | 2024-12-16 |
| Last Update Date | 2024-12-16 |