| NPI | 1841946142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA121507) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: MA PA8659) | |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2026-06-15 |