| NPI | 1548519143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110004958) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C04749) |
| 363A00000X Physician Assistant (Licence: DC PA030821) | |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2022-09-02 |