| NPI | 1841624483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 8193) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601006737) |
| Enumeration Date | 2013-08-31 |
| Last Update Date | 2021-02-11 |