| NPI | 1396281200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 6270) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 8236) |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2024-11-19 |