| NPI | 1326597030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006636) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2024-09-03 |