| NPI | 1427023449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9106441) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA000440L) |
| 363A00000X Physician Assistant (Licence: PA MA003096L) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2024-08-20 |