| NPI | 1851088447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9117362) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2023-05-02 |