| NPI | 1285214874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 6951) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA8314) |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2026-06-10 |