| NPI | 1902520968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PR 1444-P.A.) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PR 1444) |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2023-03-27 |