| NPI | 1164098570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 8344) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: AZ 8344) |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2022-12-05 |