| NPI | 1346835931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 5439-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 107218) |
| Enumeration Date | 2021-03-04 |
| Last Update Date | 2022-09-27 |