| NPI | 1477101152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA-1260) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-09615) |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2024-04-10 |