| NPI | 1912571548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL TPPA939) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 2507PA) |
| 104100000X Social Worker | |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2025-08-07 |