| NPI | 1831523083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 6682) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110004354) |
| Enumeration Date | 2013-08-23 |
| Last Update Date | 2019-08-27 |