| NPI | 1184070740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 7958) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 6009) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2025-09-15 |