| NPI | 1669460986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9117281) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA02632) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2023-08-04 |