| NPI | 1114231693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: ID PA-1251) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA1251) |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2024-03-13 |