| NPI | 1053330480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 102155) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 102155) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2023-12-07 |