| NPI | 1992182463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA.1851) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2022-11-28 |