| NPI | 1437842572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA064709) |
| Enumeration Date | 2023-06-02 |
| Last Update Date | 2024-03-21 |