| NPI | 1497182109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3401-23) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: WI 3401-23) | |
| Enumeration Date | 2013-09-27 |
| Last Update Date | 2023-11-10 |