| NPI | 1417064528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 1789-023) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 8058) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2025-03-12 |