| NPI | 1427700970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 4317) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC PA4317) |
| Enumeration Date | 2022-01-25 |
| Last Update Date | 2024-04-29 |