| NPI | 1396446761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 6035) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110009230) |
| Enumeration Date | 2023-03-13 |
| Last Update Date | 2024-08-27 |