| NPI | 1336585421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PR 002968-PA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9593202) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2026-02-25 |