| NPI | 1427593136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9119152) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1804) |
| Enumeration Date | 2017-01-04 |
| Last Update Date | 2024-12-20 |