| NPI | 1245570324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9112386) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 016442) |
| Enumeration Date | 2013-02-26 |
| Last Update Date | 2023-03-24 |