| NPI | 1881920809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9105921) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601005681) |
| Enumeration Date | 2009-10-27 |
| Last Update Date | 2024-05-29 |