| NPI | 1548316284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IA 001546) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IA 01546) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2023-01-17 |