| NPI | 1609017441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110002994) |
| Enumeration Date | 2009-03-06 |
| Last Update Date | 2024-06-28 |