| NPI | 1003243437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SD 1374) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 5440) |
| Enumeration Date | 2013-09-30 |
| Last Update Date | 2024-06-26 |