| NPI | 1447361746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9102205) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601005453) |
| 363A00000X Physician Assistant (Licence: NC 0010-06098) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2024-09-05 |