| NPI | 1528008547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 1171) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN MB1192183) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2023-02-14 |