| NPI | 1073233235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK 215874) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA0008432) |
| 363A00000X Physician Assistant (Licence: CA PA65486) | |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2024-12-24 |