| NPI | 1073632022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC MPA.5574) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2025-11-15 |