| NPI | 1437187002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA002841L) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C0002134) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2025-12-05 |