| NPI | 1831120575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DC PA200002257) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C02807) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2025-09-30 |