| NPI | 1770530883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9103928) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 009818) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2024-07-03 |