| NPI | 1134432313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA1887) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 5961) |
| 363A00000X Physician Assistant (Licence: OR PA174427) | |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2026-01-21 |