| NPI | 1275150344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601010024) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2020-10-19 |