| NPI | 1588273338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AK 161091) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MT 91400) |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2025-05-08 |