| NPI | 1558834788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601008946) |
| Enumeration Date | 2019-01-10 |
| Last Update Date | 2024-02-12 |