| NPI | 1932722238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C5-0011691) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA061502) |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2022-03-30 |