| NPI | 1720044027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9104010) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN PA821) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2019-07-29 |