| NPI | 1033525977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DC PA031061) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0005446) |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2019-06-15 |