| NPI | 1386324820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA064635) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA006524) |
| Enumeration Date | 2023-07-19 |
| Last Update Date | 2024-04-29 |