| NPI | 1619396223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2983) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 12619) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2022-03-24 |