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 |