| NPI | 1023330222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 005765) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 5765) |
| Enumeration Date | 2010-02-16 |
| Last Update Date | 2012-05-15 |