| NPI | 1669898474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AK 1182) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AK 2321) |
| Enumeration Date | 2014-03-17 |
| Last Update Date | 2019-04-03 |