| NPI | 1801439815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1844) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 57238) |
| Enumeration Date | 2019-10-22 |
| Last Update Date | 2021-07-02 |