| NPI | 1518441823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9111697) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2018-09-21 |
| Last Update Date | 2020-06-25 |