| NPI | 1861206518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: SC 5802) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| Enumeration Date | 2025-02-04 |
| Last Update Date | 2025-06-12 |