| NPI | 1851053979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9419) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 1107-P.A.) |
| Enumeration Date | 2021-10-06 |
| Last Update Date | 2023-04-10 |