| NPI | 1447806625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9115799) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 023851) |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2022-08-25 |