| NPI | 1699443036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9568) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 5508666-8002) |
| Enumeration Date | 2021-08-31 |
| Last Update Date | 2023-03-09 |