| NPI | 1922409002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601009949) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801090790) |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2022-04-26 |