| NPI | 1053846659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 7195) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C06468) |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2023-06-09 |