| NPI | 1447359187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 4654) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC PA4654) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2025-11-14 |