| NPI | 1023415528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 7437) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9109166) |
| Enumeration Date | 2014-11-26 |
| Last Update Date | 2016-04-07 |