| NPI | 1194766675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9108409) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 000309) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2016-10-06 |