| NPI | 1144870841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PR 442-P.A.) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PR 442-PA) |
| Enumeration Date | 2019-09-14 |
| Last Update Date | 2023-01-20 |