| NPI | 1215480678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9110588) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 008145) |
| 363A00000X Physician Assistant (Licence: TN 3384) | |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2024-11-14 |