| NPI | 1932211356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9100651) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL PA9100651) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2016-06-16 |