| NPI | 1801236310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C5-0012076) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0009530) |
| 363A00000X Physician Assistant (Licence: PA MA056177) | |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2024-10-07 |