| NPI | 1144561028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA.884) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA 9107034) |
| Enumeration Date | 2013-03-02 |
| Last Update Date | 2013-03-02 |