| NPI | 1487170411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110009296) |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2024-11-14 |