| NPI | 1629620034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 8416) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 265-P.A) |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2023-02-06 |