| NPI | 1942859483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: SC MPA3438) |
| 208000000X Pediatrics (Licence: SC MPA3438) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: SC MPA3438) | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2019-09-07 |
| Last Update Date | 2023-01-30 |