| NPI | 1013283076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA-473) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AR P-T1209) |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2012-04-18 |