| NPI | 1720527385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0006259) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0012098) |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2024-10-01 |