| NPI | 1366174468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PR 001303-P.A.) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NH EL09241) |
| 363AM0700X Physician Assistant, Medical (Licence: IN TS0001272.) | |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2022-06-28 |