| NPI | 1649883570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PACN1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL TPPA184) |
| 363A00000X Physician Assistant (Licence: PR 000758-PA) | |
| 363A00000X Physician Assistant (Licence: AZ 8551) | |
| Enumeration Date | 2020-08-29 |
| Last Update Date | 2025-01-31 |