| NPI | 1427358613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9105706) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 5375) |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2016-11-16 |