| NPI | 1841384435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9112493) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SD 0869) |
| 363AS0400X Physician Assistant, Surgical (Licence: IA 002397) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2021-02-23 |