| NPI | 1255877981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9110026) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9102926) |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9110026) | |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2023-10-30 |