| NPI | 1881022960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1775) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 1775) |
| Enumeration Date | 2013-10-28 |
| Last Update Date | 2023-08-30 |