| NPI | 1215545934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-13935) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2024-12-05 |