| NPI | 1073587432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 0394) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 0394P) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2023-02-20 |