| NPI | 1427486760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001004566) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL 1100) |
| Enumeration Date | 2013-10-24 |
| Last Update Date | 2023-05-26 |