| NPI | 1053167361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: PR 17479-I) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PR 2164) |
| Enumeration Date | 2024-04-26 |
| Last Update Date | 2025-07-10 |