| NPI | 1003832536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IA 001689) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IA 1689) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2009-11-12 |