| NPI | 1447509443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 006572) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9112242) |
| 363A00000X Physician Assistant (Licence: SC PA1921) | |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2022-04-29 |