| NPI | 1700032125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: DC PA030771) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61227638) |
| 363AS0400X Physician Assistant, Surgical (Licence: DE C50000627) | |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2022-03-18 |