| NPI | 1598499865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MD C0009487) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110010212) |
| Enumeration Date | 2022-07-13 |
| Last Update Date | 2025-01-10 |