| NPI | 1427743269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA064673) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-04-07 |
| Last Update Date | 2023-08-29 |