| NPI | 1740502483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DC PA030580) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0004180) |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2022-11-16 |