| NPI | 1871528406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9107868) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 001649) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2020-11-18 |