| NPI | 1851983886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PABP.BG.61267147) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9114002) |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2022-04-12 |