| NPI | 1427506575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2610) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-11939) |
| Enumeration Date | 2016-09-19 |
| Last Update Date | 2023-03-02 |