| NPI | 1649769837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9111237) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: FL PA9111237) |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2024-10-11 |