| NPI | 1558961987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9118358) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL ps41404) |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2024-01-24 |