| NPI | 1760786172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: DC PA030586) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MD C0003952) |
| Enumeration Date | 2010-12-28 |
| Last Update Date | 2010-12-28 |