| NPI | 1306099155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5356) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA053715) |
| Enumeration Date | 2008-10-24 |
| Last Update Date | 2026-04-03 |