| NPI | 1881431229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA065608) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA OA006880) |
| Enumeration Date | 2024-07-12 |
| Last Update Date | 2024-07-12 |