| NPI | 1447241831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9101891) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: FL PA9101891) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2016-02-26 |