| NPI | 1144290321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MD C0003519) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110001879) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2023-03-07 |