| NPI | 1497942858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 002045) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA 9103709) |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2018-08-14 |