| NPI | 1437119070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA PARXA10379) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: LA PA.A10379) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2023-11-07 |