| NPI | 1851274922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9120887) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2025-07-28 |
| Last Update Date | 2025-11-03 |