| NPI | 1457610438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 4995) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2024-06-12 |