| NPI | 1588143101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601009745) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 026267) |
| 363A00000X Physician Assistant (Licence: FL PA9111522) | |
| 363A00000X Physician Assistant (Licence: IL 085007763) | |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2024-02-28 |