| NPI | 1295770691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA3131) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: FL PA3131) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2021-11-19 |