| NPI | 1720332844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0004755) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA030848) |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2021-06-02 |