| NPI | 1497384168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 8320) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PR 154) |
| Enumeration Date | 2020-04-05 |
| Last Update Date | 2025-02-07 |