| NPI | 1497248694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110006245) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2023-09-12 |