| NPI | 1396345427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 10442) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 1668) |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2025-05-08 |