| NPI | 1386978682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9106688) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NE 1467) |
| 363AM0700X Physician Assistant, Medical (Licence: GA 6435) | |
| Enumeration Date | 2009-09-21 |
| Last Update Date | 2014-09-03 |