| NPI | 1033530605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AR PA-546) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AR PA-546) |
| Enumeration Date | 2013-12-26 |
| Last Update Date | 2021-08-04 |