| NPI | 1528311826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-03834) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 6967148-1206) |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2024-03-07 |