| NPI | 1114443587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 6927) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0110-005837) |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2022-07-21 |