| NPI | 1235859182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PR 001058-P.A) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 001058) |
| Enumeration Date | 2022-08-31 |
| Last Update Date | 2024-06-28 |