| NPI | 1659716041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 6831) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 006831) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2021-04-22 |