| NPI | 1588025563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1829) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9109370) |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2022-03-07 |