| NPI | 1336774488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 5230-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 100051) |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2022-09-12 |