| NPI | 1700311180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PACN42) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PR 2418) |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2025-05-19 |