| NPI | 1720092943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9118780) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AR PA-1273) |
| 363A00000X Physician Assistant (Licence: MI 5601002945) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2024-05-13 |