| NPI | 1972621258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: AZ 3244) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: AZ 2344) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2020-09-01 |