| NPI | 1831503259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 7192) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA2300) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2022-08-08 |