| NPI | 1821564972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0006989) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA031556) |
| Enumeration Date | 2018-10-16 |
| Last Update Date | 2021-09-27 |