| NPI | 1538303086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0009163) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA6460) |
| Enumeration Date | 2009-04-28 |
| Last Update Date | 2024-01-10 |