| NPI | 1982898565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: MD C0003111) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2023-04-06 |