| NPI | 1780306365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA.2413) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 11217) |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2024-07-25 |