| NPI | 1174252845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 145297) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID 3561177) |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2024-11-26 |