| NPI | 1548203003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA222672) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10000431A) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2024-10-30 |