| NPI | 1841545902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 8231-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA1764) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2025-02-12 |