| NPI | 1023668209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA7237) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 60988) |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2024-04-26 |