| NPI | 1700390291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9118531) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS51967) |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2024-07-19 |