| NPI | 1437456092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: DC PA031714) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 014620-1) |
| Enumeration Date | 2011-02-17 |
| Last Update Date | 2020-06-19 |