| NPI | 1396736336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 002321) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 002321) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2024-11-03 |