| NPI | 1457387383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 102251) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 1024762) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2024-03-11 |