| NPI | 1831151125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9105464) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C00332) |
| 363A00000X Physician Assistant (Licence: FL PA9109616) | |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2020-08-28 |