| NPI | 1093146375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2287) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 007063) |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2021-06-08 |