| NPI | 1003066549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C03884) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD 1080306) |
| Enumeration Date | 2008-09-21 |
| Last Update Date | 2009-05-15 |