| NPI | 1033500541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601010725) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10003965A) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2015-02-05 |
| Last Update Date | 2025-10-20 |