| NPI | 1861827966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9110372) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA056346) |
| Enumeration Date | 2013-09-08 |
| Last Update Date | 2018-06-18 |