| NPI | 1043628183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA060229) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: DE C5-0001382) | |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2024-09-12 |