| NPI | 1427540780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08222) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2018-06-03 |
| Last Update Date | 2024-08-21 |