| NPI | 1952952921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DC PA200001866) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4745-23) |
| Enumeration Date | 2019-09-21 |
| Last Update Date | 2024-04-24 |