| NPI | 1841234630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA002426L) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C50000117) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2022-03-09 |