| NPI | 1801532676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-13270) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-13270) |
| 363AM0700X Physician Assistant, Medical (Licence: VA 0110008838) | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2022-05-05 |
| Last Update Date | 2024-11-11 |