| NPI | 1427524008 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA91117347) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9111734) |
| Enumeration Date | 2018-10-22 |
| Last Update Date | 2022-09-01 |