| NPI | 1760683320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 005235) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA-9104168) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2010-06-03 |