| NPI | 1598386302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-10291) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-05-04 |
| Last Update Date | 2020-11-27 |