| NPI | 1427899053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-14485) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2024-06-06 |
| Last Update Date | 2024-09-24 |