| NPI | 1396173969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-04942) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-04942) |
| 363AM0700X Physician Assistant, Medical (Licence: MD c0005208) | |
| Enumeration Date | 2013-10-17 |
| Last Update Date | 2024-01-23 |