| NPI | 1801252895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9113605) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NM PA2016002) |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2021-03-09 |