| NPI | 1457196362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PR 002163-P.A.) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL TPPA763) |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2024-09-26 |