| NPI | 1205878410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 714) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC A714) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2022-11-01 |