| NPI | 1386184216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005692) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 3215) |
| Enumeration Date | 2017-02-25 |
| Last Update Date | 2024-08-27 |