| NPI | 1255482683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID PA-1370) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO 2365) |
| Enumeration Date | 2007-01-14 |
| Last Update Date | 2024-11-26 |