| NPI | 1992765747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0009860) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9108323) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2025-05-21 |