| NPI | 1891867396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9110250) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 002093) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2019-06-03 |