| NPI | 1871975904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 6498) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 7608) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2025-04-08 |