| NPI | 1275935934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2189) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC TL2189) |
| Enumeration Date | 2014-09-24 |
| Last Update Date | 2024-08-30 |