| NPI | 1386797983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9117585) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 002284) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2024-12-18 |