| NPI | 1184811986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-747) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 2437) |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2023-11-25 |