| NPI | 1841432549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-03808) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 110002941) |
| Enumeration Date | 2009-03-27 |
| Last Update Date | 2024-03-18 |