| NPI | 1144537945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT MED-PAC-LIC-617) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 617) |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2024-02-19 |