| NPI | 1881970044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 2336) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GU PA-82) |
| Enumeration Date | 2011-11-01 |
| Last Update Date | 2020-09-08 |