| NPI | 1811250822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: DE c50001286) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA055522) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2020-03-25 |