| NPI | 1144760687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA-708) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AR PT2017-014) |
| Enumeration Date | 2017-03-02 |
| Last Update Date | 2019-02-22 |