| NPI | 1346544764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-14260) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 008687) |
| 363A00000X Physician Assistant (Licence: TX 1092269) | |
| Enumeration Date | 2010-12-28 |
| Last Update Date | 2025-03-28 |