| NPI | 1497843643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9117438) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9117438) |
| 363AM0700X Physician Assistant, Medical (Licence: MI 5601003596) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2025-01-06 |