| NPI | 1033441480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-04010) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1197) |
| Enumeration Date | 2010-02-10 |
| Last Update Date | 2013-03-06 |