| NPI | 1790370286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4449) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 110009747) |
| Enumeration Date | 2021-03-05 |
| Last Update Date | 2024-03-19 |