| NPI | 1316196272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9104772) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10001208A) |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2015-08-17 |