| NPI | 1124564000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 4332) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 6442) |
| Enumeration Date | 2017-01-16 |
| Last Update Date | 2024-05-28 |