| NPI | 1023041944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA001892L) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA000312L) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2016-05-10 |