| NPI | 1295793370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 4940) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-00990) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2022-01-26 |