| NPI | 1639316078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-13640) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 17680) |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2023-12-14 |