| NPI | 1003107640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: FL PA9107253) |
| 363A00000X Physician Assistant | |
| 363AS0400X Physician Assistant, Surgical | |
| 363A00000X Physician Assistant (Licence: FL 9107253) | |
| Enumeration Date | 2011-05-01 |
| Last Update Date | 2014-01-29 |