| NPI | 1851935662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1822) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 9790) |
| Enumeration Date | 2019-11-05 |
| Last Update Date | 2021-05-14 |