| NPI | 1235193400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA2616) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA2616) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2024-03-26 |