| NPI | 1952655748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 1834) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC TL1834) |
| Enumeration Date | 2012-11-01 |
| Last Update Date | 2021-05-24 |