| NPI | 1326405846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA058072) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA OA003738) |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2022-09-29 |