| NPI | 1366459224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9120129) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-00321) |
| 363AS0400X Physician Assistant, Surgical (Licence: AR PA-1270) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2025-04-29 |