| NPI | 1407163439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C04306) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD T0004306) |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2022-03-09 |