| NPI | 1487834297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 4778) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 4778) |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9104364) | |
| Enumeration Date | 2007-11-08 |
| Last Update Date | 2023-10-19 |