| NPI | 1588288203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9733) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL HSE32842) |
| 208600000X Surgery (Licence: IL 238000625) | |
| 208D00000X General Practice (Licence: PR TPPA373) | |
| 363A00000X Physician Assistant (Licence: FL TPPA373) | |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2023-07-06 |