| NPI | 1609323690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA058458) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0011471) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2024-04-09 |