| NPI | 1427515782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 5848) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA 60932663) |
| Enumeration Date | 2019-02-22 |
| Last Update Date | 2024-06-20 |