| NPI | 1588019087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007928) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2024-04-03 |