| NPI | 1164411989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: AK PAD A 1056) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK PAD A 1056) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2016-09-13 |