| NPI | 1699448530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4691) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 1188615) |
| Enumeration Date | 2021-07-27 |
| Last Update Date | 2022-02-16 |