| NPI | 1932706744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0011853) |
| 363A00000X Physician Assistant (Licence: MD C0008580) | |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2024-06-03 |