| NPI | 1215439286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 8691) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 008691) |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2024-02-06 |