| NPI | 1558372748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK 160483) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA 9103961) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2020-08-26 |