| NPI | 1245584978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 12020) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9106728) |
| Enumeration Date | 2012-11-02 |
| Last Update Date | 2024-01-24 |