| NPI | 1275021982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA065176Credential) |
| Additional Taxonomies | 170300000X Genetic Counselor, MS |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2023-10-25 |