| NPI | 1649669045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3027) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9108500) |
| 363AS0400X Physician Assistant Surgical (Licence: TN 3027) | |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2024-05-24 |