| NPI | 1346295094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601003407) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI SG003407) |
| 363A00000X Physician Assistant (Licence: MI 5601003407) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2024-07-07 |