| NPI | 1972963197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DC PA200001920) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110007626) |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2016-03-01 |
| Last Update Date | 2024-07-16 |