| NPI | 1558702670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3183) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 3183-23) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2023-03-27 |