| NPI | 1720718281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 10542) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P10050) |
| Enumeration Date | 2022-06-15 |
| Last Update Date | 2024-10-16 |