| NPI | 1861943946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0006282) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110011289) |
| Enumeration Date | 2016-10-24 |
| Last Update Date | 2026-02-19 |