| NPI | 1992831895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: LA PA.A10405) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: LA PA10405) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2023-05-10 |