| NPI | 1942699723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2268) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC MPA.2268 PA) |
| Enumeration Date | 2015-01-15 |
| Last Update Date | 2025-03-07 |