| NPI | 1760992051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9115335) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 021400) |
| 363A00000X Physician Assistant (Licence: FL PA9115335) | |
| Enumeration Date | 2017-10-02 |
| Last Update Date | 2023-04-07 |