| NPI | 1710006788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 005797) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA 9101142) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2018-07-11 |