| NPI | 1932926193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-14847) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2024-09-20 |
| Last Update Date | 2025-04-04 |