| NPI | 1255866356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 087446) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 3127) |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2024-02-21 |