| NPI | 1700993250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 1795) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 102396) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2023-07-28 |