| NPI | 1619299831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-2675) |
| Enumeration Date | 2010-02-16 |
| Last Update Date | 2023-12-05 |