| NPI | 1699749366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601003863) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 5601003863) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2019-09-04 |