| NPI | 1326550914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4596) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 090942) |
| Enumeration Date | 2017-11-03 |
| Last Update Date | 2023-05-11 |