| NPI | 1144504556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1593) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2024-09-20 |