| NPI | 1528075934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9103814) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 59022) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-07-21 |