| NPI | 1952069387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PR 1150-P.A.) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 9539) |
| Enumeration Date | 2021-12-02 |
| Last Update Date | 2023-02-23 |