| NPI | 1861625683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 1811) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA053992) |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2023-10-27 |