| NPI | 1093724742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2931) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 170) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2022-07-20 |