| NPI | 1275568636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA PA.A10633) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA A10633) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2026-04-27 |