| NPI | 1265027338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PR 922) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL 120) |
| Enumeration Date | 2021-03-01 |
| Last Update Date | 2021-03-01 |