| NPI | 1114101813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3241-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10000978A) |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2021-06-17 |