| NPI | 1598173569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 364SF0001X Clinical Nurse Specialist, Family Health (Licence: TN 2551) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2024-05-15 |