| NPI | 1538565270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1744) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9108385) |
| Enumeration Date | 2014-11-07 |
| Last Update Date | 2021-07-20 |