| NPI | 1336453935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PR 1601) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 12697) |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2023-04-21 |