| NPI | 1447337688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601003566) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA19796) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2025-01-23 |