| NPI | 1083002570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10769) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 2677) |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2023-10-18 |