| NPI | 1881725711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 0629) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-09939) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2023-10-27 |