| NPI | 1396806402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DC PA030502) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA A10406) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2023-01-24 |