| NPI | 1952956963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9682) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 001267-PA) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2023-10-03 |