| NPI | 1528429172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: ID PA-1360) |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2022-01-06 |