| NPI | 1841474244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1594) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KS 1501483) |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2023-01-08 |