| NPI | 1093050098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: DE C5-0000852) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: DE C5-0000852) |
| Enumeration Date | 2012-12-01 |
| Last Update Date | 2012-12-01 |