| NPI | 1568006682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 10288) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PR 000417-P.A.) |
| Enumeration Date | 2019-10-31 |
| Last Update Date | 2025-08-14 |