| NPI | 1982611893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-2188) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 2383) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2025-07-25 |