| NPI | 1538771373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 5161-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 2523) |
| Enumeration Date | 2020-08-22 |
| Last Update Date | 2023-06-26 |