| NPI | 1073788022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC PA1733) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: SC PA1733) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2025-09-15 |