| NPI | 1144773052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9115372) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 2574) |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2022-04-11 |