| NPI | 1033778626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601009190) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5601009190) |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2024-12-10 |