| NPI | 1669509196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 002033) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA2799) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2013-07-09 |