| NPI | 1043939945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9299) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ Pending) |
| Enumeration Date | 2022-08-24 |
| Last Update Date | 2022-10-07 |