| NPI | 1851744999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MD C0009216) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110-005442) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2023-12-18 |