| NPI | 1871986463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA061366) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD c0005709) |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2024-05-13 |