| NPI | 1811768351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 5830) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: TN 5830) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2024-01-12 |
| Last Update Date | 2025-03-26 |