| NPI | 1851103600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA066351) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OA007162) |
| Enumeration Date | 2025-01-20 |
| Last Update Date | 2025-10-07 |