| NPI | 1285908095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: DC PA200001329) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110008374) |
| 363AM0700X Physician Assistant, Medical (Licence: CA 52529) | |
| 363AM0700X Physician Assistant, Medical (Licence: HI AMD-449) | |
| Enumeration Date | 2012-02-27 |
| Last Update Date | 2022-11-15 |