| NPI | 1588844351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9107328) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: HI AMD-309) |
| Enumeration Date | 2007-11-09 |
| Last Update Date | 2019-11-19 |