| NPI | 1285763391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110002350) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA030452) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2021-09-21 |