| NPI | 1528395928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 005709) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9112412) |
| Enumeration Date | 2009-11-06 |
| Last Update Date | 2024-12-05 |