| NPI | 1821866625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 8592-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 8592) |
| Enumeration Date | 2023-12-12 |
| Last Update Date | 2026-02-12 |