| NPI | 1063554525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA-052918) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA052918) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2013-02-22 |