| NPI | 1235691643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: DC PA200001836) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: DC SLP001560) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2024-01-03 |