| NPI | 1568433936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA053484) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C50000295) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2024-04-17 |