| NPI | 1699339101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110007013) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0110007013) |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2024-02-02 |