| NPI | 1750541579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA056068) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA003020) |
| 363A00000X Physician Assistant (Licence: PA MD1844530) | |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2025-04-18 |