| NPI | 1861726259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1351) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9105223) |
| Enumeration Date | 2009-10-01 |
| Last Update Date | 2022-11-17 |