| NPI | 1952989709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9055) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 32150) |
| 363A00000X Physician Assistant (Licence: PR 1209P.A) | |
| 363A00000X Physician Assistant (Licence: PR 1209P.A.) | |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2023-02-09 |