| NPI | 1841660487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001005988) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA 349866) |
| Enumeration Date | 2015-09-25 |
| Last Update Date | 2026-03-17 |