| NPI | 1932206091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA2602) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA0002602) |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2026-05-18 |