| NPI | 1992825152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9116822) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-01166) |
| 363A00000X Physician Assistant (Licence: GA 005034) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2024-05-09 |