| NPI | 1306512371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4743) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110008072) |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2025-02-28 |