| NPI | 1326794694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AL PA.1934) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 3093) |
| Enumeration Date | 2022-02-25 |
| Last Update Date | 2025-11-19 |