| NPI | 1831476175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-444) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601006035) |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2021-05-17 |