| NPI | 1003922790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK 1027) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 375970-1206) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2023-03-07 |