| NPI | 1487153078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9115276) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9115276) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2018-02-08 |
| Last Update Date | 2024-07-08 |