| NPI | 1992347793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C07710) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC RN1015131) |
| 363A00000X Physician Assistant (Licence: DC PA031854) | |
| Enumeration Date | 2019-10-13 |
| Last Update Date | 2020-10-16 |