| NPI | 1396728994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601004451) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 99018815A) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2023-03-07 |