| NPI | 1609852573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-993) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA030365) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2023-02-23 |