| NPI | 1336553965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 3432) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NE 1190) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2026-06-14 |