| NPI | 1124353883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 4380) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 1084942) |
| Enumeration Date | 2009-10-13 |
| Last Update Date | 2022-03-07 |