| NPI | 1740235829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AK PADA482) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: AK 482) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2023-03-07 |