| NPI | 1417713181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 124226) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 3057) |
| Enumeration Date | 2024-02-21 |
| Last Update Date | 2024-02-21 |