| NPI | 1306683826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PACN6) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 002214) |
| Enumeration Date | 2024-07-11 |
| Last Update Date | 2025-02-05 |