| NPI | 1336019140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA067337) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA OA007712) |
| Enumeration Date | 2025-11-06 |
| Last Update Date | 2026-05-11 |