| NPI | 1194411801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0010230) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110011509) |
| 363A00000X Physician Assistant (Licence: DC PA200002441) | |
| Enumeration Date | 2023-04-14 |
| Last Update Date | 2026-03-24 |