| NPI | 1427021377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9106628) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 003178) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2014-02-25 |