| NPI | 1427148634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011632) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK 677) |
| 363A00000X Physician Assistant (Licence: CA PA16861) | |
| 363A00000X Physician Assistant (Licence: WI 3262-23) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2024-05-22 |