| NPI | 1437756228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9120471) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA OA005274) |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2025-09-26 |