| NPI | 1285184812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9114952) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 246RP1900X Technician, Pathology, Phlebotomy | |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2022-11-07 |