| NPI | 1598927071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9107856) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 1094) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2016-06-16 |