| NPI | 1841150430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PR 002888-P.A.) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL TPPA1098) |
| Enumeration Date | 2025-11-14 |
| Last Update Date | 2026-01-16 |