| NPI | 1497063549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD c04318) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA031932) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2023-01-09 |