| NPI | 1861668758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C03750) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110001725) |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2024-02-09 |