| NPI | 1841956778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110007956) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA20001279) |
| Enumeration Date | 2021-11-15 |
| Last Update Date | 2024-01-04 |