| NPI | 1346829124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA.1872) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2023-12-11 |