| NPI | 1437649647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA8005) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 3570) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2022-07-25 |