| NPI | 1356773477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA056268) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MH3221479) |
| 363A00000X Physician Assistant (Licence: PA OA003090) | |
| Enumeration Date | 2013-07-31 |
| Last Update Date | 2021-06-04 |