| NPI | 1710132865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9253) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA053781) |
| Enumeration Date | 2008-11-17 |
| Last Update Date | 2024-05-16 |