| NPI | 1326061623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 3410) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 905) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2022-06-28 |