| NPI | 1710424254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9113597) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2017-01-23 |
| Last Update Date | 2023-06-22 |