| NPI | 1730684457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 8020-23) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 3320) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2024-07-10 |