| NPI | 1043312572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 004878) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 004878) |
| 363A00000X Physician Assistant (Licence: SC PA1183) | |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2009-12-23 |