| NPI | 1609847714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9109674) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 003402) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2021-01-11 |