| NPI | 1437835618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA006503) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA064563) |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2023-06-23 |