| NPI | 1174563837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 516) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 683) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2023-03-21 |