| NPI | 1447533716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: FL PA 9104076) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: GA 004419) |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2011-09-23 |