| NPI | 1336925585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DC PA200001841) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C09181) |
| Enumeration Date | 2023-09-05 |
| Last Update Date | 2024-09-25 |