| NPI | 1750756755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9109264) |
| Enumeration Date | 2015-12-02 |
| Last Update Date | 2021-01-20 |