| NPI | 1447816152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: AZ 7442) |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2021-04-16 |