| NPI | 1689996449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-02195) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2010-02-22 |
| Last Update Date | 2024-03-13 |