| NPI | 1659862357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0001223) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2022-06-22 |