| NPI | 1124544036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008627) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10002351A) |
| 363A00000X Physician Assistant (Licence: FL PA9119696) | |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2025-02-07 |