| NPI | 1851362537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA PA1161) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601012910) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2025-03-31 |