| NPI | 1558317701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9103488) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AL PA-838) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2017-01-05 |