| NPI | 1679707301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 5868) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC PA1567) |
| Enumeration Date | 2009-05-09 |
| Last Update Date | 2024-08-14 |