| NPI | 1932456845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-2227) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2024-04-04 |