| NPI | 1306146444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110003506) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110003506) |
| 363AM0700X Physician Assistant, Medical (Licence: DC PA030775) | |
| 363AM0700X Physician Assistant, Medical (Licence: MD C04331) | |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2022-02-17 |