| NPI | 1497473896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 10296) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 1365-P.A.) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2024-03-31 |