| NPI | 1376857011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C50000957) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0004266) |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2024-04-04 |