| NPI | 1497060727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA064644) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0004217) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2024-03-13 |