| NPI | 1629013032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI 367) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 581) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2024-02-15 |