| NPI | 1952635732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9105158) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PAT9105158) |
| Enumeration Date | 2009-09-25 |
| Last Update Date | 2023-11-27 |