| NPI | 1023254935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK 835) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK PAD T 2002) |
| Enumeration Date | 2008-12-23 |
| Last Update Date | 2012-12-04 |