| NPI | 1528578515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 6939) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 6939) |
| 363AS0400X Physician Assistant, Surgical (Licence: AZ 6939) | |
| Enumeration Date | 2017-10-04 |
| Last Update Date | 2023-04-14 |