| NPI | 1295989408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-331) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 4221) |
| Enumeration Date | 2008-11-14 |
| Last Update Date | 2024-01-15 |