| NPI | 1144650201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: FL PA 9107668) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA 9107668) |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2015-04-12 |