| NPI | 1184615239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 100436) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NC 100436) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2016-07-12 |