| NPI | 1013034040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1411) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 002162) |
| 363A00000X Physician Assistant (Licence: ND PAC1057) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2025-05-06 |