| NPI | 1447539648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9119228) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA055365) |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2024-10-24 |