| NPI | 1386695211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA1957) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA10005012) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2015-06-26 |