| NPI | 1568350593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0010064) |
| Enumeration Date | 2025-06-26 |
| Last Update Date | 2025-08-06 |