| NPI | 1497931810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TN 2326) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA 9103020) |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2013-04-11 |