| NPI | 1932604790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR pa205588) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9111003) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2023-07-12 |