| NPI | 1346522687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9116155) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: 1108163) |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2023-06-27 |