| NPI | 1740471416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0008153) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1095604) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2024-06-03 |