| NPI | 1457896268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4665) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110005604) |
| 363A00000X Physician Assistant (Licence: NC 0010-07251) | |
| Enumeration Date | 2017-01-03 |
| Last Update Date | 2024-11-24 |