| NPI | 1467935635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 79074) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 7233) |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2024-03-04 |