| NPI | 1598434649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 2545) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 2947) |
| Enumeration Date | 2021-09-12 |
| Last Update Date | 2023-08-18 |