| NPI | 1659308708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0001721) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA003126) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2025-09-11 |