| NPI | 1437519972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0007560) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2016-02-25 |
| Last Update Date | 2023-08-10 |