| NPI | 1538376538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9103393) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA 000373L) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2015-11-23 |