| NPI | 1720457351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 7003) |
| 207QB0002X Family Medicine, Bariatric Medicine (Licence: AZ 7003) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 7003) | |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2023-07-15 |