| NPI | 1306072343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 109718) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA.1011) |
| 363A00000X Physician Assistant (Licence: TN 2099) | |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2022-05-02 |