| NPI | 1790959369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C03648) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA030527) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2023-07-21 |