| NPI | 1649209354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601003027) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 798) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2023-09-28 |