| NPI | 1043862071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA064705) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0007226) |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2023-11-24 |