| NPI | 1659083467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: DC PA200001635) |
| Additional Taxonomies | 251K00000X Public Health or Welfare |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2022-12-23 |
| Last Update Date | 2023-03-29 |