| NPI | 1831087550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110011287) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2025-06-24 |
| Last Update Date | 2025-10-17 |