| NPI | 1275375909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA200001966) |
| Enumeration Date | 2024-06-12 |
| Last Update Date | 2024-08-28 |