| NPI | 1518459049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DC PA031489) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA09119529) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2025-06-18 |