| NPI | 1821617036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9684) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: GA 9684) |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2021-08-27 |