| NPI | 1730146176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9108575) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-00096) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2015-05-24 |