| NPI | 1801125034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-923) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 1090604) |
| Enumeration Date | 2009-12-17 |
| Last Update Date | 2023-08-22 |