| NPI | 1033698550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DC PA031467) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA60547) |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2023-04-07 |