| NPI | 1609348929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA004750) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: PA OA004750) |
| Enumeration Date | 2018-12-27 |
| Last Update Date | 2021-02-18 |