| NPI | 1912521444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AL 2360) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL 2360) |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2024-03-29 |