| NPI | 1518252725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2011013290) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AR PA-488) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2023-05-10 |