| NPI | 1679675540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9100607) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL PA9100607) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2009-10-22 |