| NPI | 1972154565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9118913) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 024083) |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2024-10-24 |