| NPI | 1487284501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9612) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 13384) |
| Enumeration Date | 2020-01-16 |
| Last Update Date | 2023-05-31 |