| NPI | 1437584448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 5544) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA 60410146) |
| 363A00000X Physician Assistant (Licence: FL PA9120301) | |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2025-11-13 |