| NPI | 1770896532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0004412) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2013-10-15 |