| NPI | 1871060681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-1681) |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2024-05-15 |