| NPI | 1801830260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TN 1736) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA2726) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA2726) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2009-10-07 |