| NPI | 1992768642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9116094) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA16877) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2022-10-12 |