| NPI | 1942586300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD me2745430) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2023-10-23 |