| NPI | 1366847477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9111252) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110005489) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2018-05-25 |