| NPI | 1427448810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9108510) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PAT9108510) |
| Enumeration Date | 2015-01-23 |
| Last Update Date | 2015-01-28 |