| NPI | 1720227143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2016015683) |
| Additional Taxonomies | 1744R1102X Specialist, Research Study |
| Enumeration Date | 2009-02-09 |
| Last Update Date | 2021-03-09 |