| NPI | 1952422834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MD C02971) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: DC PA030352) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2020-11-30 |