| NPI | 1497977235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9116008) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 002111) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2024-08-23 |