| NPI | 1225099575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9115873) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 545) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2024-08-15 |