| NPI | 1043508260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: DC PA031040) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-003630) |
| 363A00000X Physician Assistant (Licence: DC PA031040) | |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2022-12-13 |