| NPI | 1598546350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C5-0011997) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0009423) |
| Enumeration Date | 2023-10-09 |
| Last Update Date | 2024-09-04 |