| NPI | 1053587188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601005186) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601005186) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2008-12-10 |