| NPI | 1144748831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 95698) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9114327) |
| Enumeration Date | 2017-09-02 |
| Last Update Date | 2022-06-14 |