| NPI | 1619162179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA-314) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AR GL-013) |
| Enumeration Date | 2007-09-07 |
| Last Update Date | 2022-08-02 |