| NPI | 1710005426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 3336) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 2336) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2020-09-01 |