| NPI | 1760994016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6349) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA PA6349) |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2024-06-25 |