| NPI | 1881218584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9078) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 10249) |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2022-05-12 |