| NPI | 1861745424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DC PA030994) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110004045) |
| Enumeration Date | 2012-10-19 |
| Last Update Date | 2014-08-11 |