| NPI | 1851403281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA2690) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL PA2690) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2013-08-08 |