| NPI | 1356369870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601003375) |
| Additional Taxonomies | 174400000X Specialist (Licence: IN 10000475a) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2021-12-15 |