| NPI | 1033825575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110010882) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-01-27 |
| Last Update Date | 2025-07-29 |