| NPI | 1841534591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 006678) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA 9106708) |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2021-08-04 |