| NPI | 1851603062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9111053) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SC MPA1559) |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2024-07-04 |