| NPI | 1366417974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 103004) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA2914) |
| Enumeration Date | 2006-02-18 |
| Last Update Date | 2014-09-11 |