| NPI | 1881777613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ T661) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 3519) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2021-05-10 |