| NPI | 1851699839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 78431) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AR PA-487) |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2021-05-27 |