| NPI | 1285671180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0002268) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110005739) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2024-09-11 |